We know that cardiac rehabilitation and exercise is an essential component of both recovery and moving forward when you have a heart condition. We also know that the benefits of cardiac rehab and regular exercise are clear – a 26% reduction in dying of a cardiovascular condition1, 18% reduced hospital admissions (1) and a reduced risk of further events (2).
Yet half of patients invited still don’t attend (3), with many stating that they didn’t feel confident to attend and many were unaware of the benefits.
A selection of 7 the UK’s top cardiac rehab trainers give their top tips for exercising when you have a heart condition that anyone attending cardiac rehab or thinking about joining a local exercise class should keep in mind.
- Angela Hartley – Healthy Hearties
After a heart attack, surgery or diagnosis, everyone reacts differently and needs different tools for success. Cardiac rehab and regular exercise can help people to move on and have a more fun and fulfilling life. Angela says “Often people are nervous, worried and anxious that exercise will hurt, damage their heart or they will not be able to do it correctly. Fear not! There are some simple ways to get back into exercise that will make things as easy and pain-free as possible.”
Angela says ‘I have so many tips but if I have to narrow it down, here are my top 3:
- Join a supportive group. This may be your local NHS cardiac rehab, a local phase 4 exercise class – search for your closest class at www.cardiacrehab.org.uk. You could also join an online support group such as the Healthy Hearties Facebook group. Chatting to others who have been through what you have can be reassuring. You can learn from others, join in the chats or watch and learn from afar. Having a support group can improve your confidence, form new friendships and give you an incentive to turn up to exercise!
- Learn and research. The more you can understand about your condition, the more you can help improve your health, fitness and quality of life. Understanding how that lifestyle changes such as diet and exercise can improve your quality of life means you’re more likely to be motivated to keep up those changes. Learn by asking your medical team questions, reading, researching books and articles and learning from others in your class. You are much more likely to stick to a program if you know the reason why it’s good for you!
- Take one step at a time. Start out slowly and build up gradually. You’ll soon be doing much more after a few weeks. With guidance from your instructor, you can add new exercises and do more and more each time. Everyone has a different goal – find out what you enjoy, set some goals and make exercise a habit. Many of my clients are walking further everyday than they did pre heart event, some have started jogging, others returned to road cycling and one has even completed a marathon!”
Angela runs Healthy Hearties, a Facebook group that offers friendship, support and advice about exercise and nutrition. She also runs online programs and sees people face to face for private exercise sessions in East Molesey, Surrey. Visit www.clinicalexercise.co.uk or www.healthyhearties.co.uk for more information.
2. Toby Whitehead – Bounceback Cardiac Rehab Exercise Programme
As a cardiac rehab exercise physiologist part of Toby’s job is to try to help people find exercise rewarding. The reward might be feeling fitter, a sense of doing the best for their health, having fun, helping with low mood and depression or something else that keeps them committed to exercising regularly, because regular exercise at the right intensity is the key.
Toby says “In the 10 years I have been a qualified instructor, I have found cardiac rehab exercise classes are a brilliant way to combine the benefits of exercise in a fun and social group. Many of my class members say things like ‘I’m not a gym person’ or ‘I wouldn’t exercise if it wasn’t for the group’. These are the same people that love the group exercise and attend up to three times per week. I think it really shows the community of the class makes a big difference in helping people commit to exercise on a regular basis.”
Over the years the people in Toby’s groups have helped each other overcome bad news and celebrate good news. They have achieved much together to raise money for local and national heart charities by doing what they can to challenge themselves physically at a sponsored event or challenge.
Toby adds, “People know they’ll always be greeted with a friendly face and an understanding of what it feels like to have had a heart problem. Ultimately they are invested in the group, both for their physical benefit and the friends they will make. My top tip is if you’re not a ‘gym’ person, then find a group to exercise with as you’ll have fun and get fit at the same time.”
Toby currently holds the position of Senior Cardiac Rehabilitation Exercise Physiologist at East Surrey Hospital. He also set up the ever-expanding Bounceback cardiac rehab exercise classes, which help to build fitness, strength and confidence after a heart problem. Bounceback also have a popular support group, which you can get involved in as much or as little as you like. Classes are available at many locations including Brighton, Crawley, Durrington, East Grinstead, Hastings, Haywards Health, Horsham, Hove, Lewes, Little Common, Seaford, Sevenoaks and Uckfield. Visit www.bbfit.co.uk/ for more information.
- The Clinical Team – Ten Health & Fitness, London
Pilates has exploded onto the mainstream fitness scene and it would appear that it is here to stay. Its potential seems limitless: improved posture, endurance, breathing, core strength and mindfulness. The Clinical Team from Ten Health & Fitness says “Pilates is fundamentally built around the principles of lean muscle development and functional movement with the added element of breath control – interestingly not far removed from a traditional cardiac rehabilitation program. Whilst the link between Pilates and those with a cardiac history is in its infancy, a few studies have been now been reported and the results are promising and we use it in our rehab sessions”.
A recent study in Brazil was conducted with patients with NYHA class I or II heart failure – one group completed 30 minutes of cardio followed by 20 minutes of Pilates and a control group followed a conventional cardiac rehab program. The cardio/Pilates group showed a greater increase in exercise time, VO2max and peak oxygen consumption versus the control group. A 16-week study published in the International Journal of Cardiology showed that two 60-minute Pilates sessions a week reduced the blood pressure of a group of over 55s taking anti-hypertensive medication to a greater extent than a group who undertook a traditional program. An initial study into the effects of an integrated Pilates based rehabilitation program on patients post CABG is also looking promising. Mr Pilates was on to something after all.
The Team concludes, “In short, it would seem as though Pilates really is for and can benefit everyone but especially those with a cardiac condition! Our top tip would be to just give it a go!”
Ten Health & Fitness has 8 locations in London and offers one-to-one cardiac rehabilitation sessions in their boutique studios that incorporates cardiovascular, resistance exercise and Pilates. Their first priority is client safety, with sessions designed around proven scientific and medical principles to help clients manage a life-changing heart condition and improve their quality of life. Visit www.ten.co.uk/clinical for more information.
- Elaine Roles – Heart Rehabilitation Exercise
Elaine considers Cardiac Rehab to be the most important decision you will ever make after a cardiac event. She states “It is not just about exercise but it can become the foundation for how you view and live your life. It will lift the limits you may have placed on what you are now able to do, it will positively affect the relationships with those around you, as well as how you feel about yourself.”
Elaine asked her regular class what they think helped them the most when they started (she still has some who have attended for 17 years) and they said: “Reassurance, laughing again, no pressure to perform, new friends, learning how to exercise safely, feeling safe and having my questions answered.” Elaine adds “One of the members wanted to know he could safely return to his normal exercise – he is a long distance runner.”
Elaine gave six points listed below that she says are just the start of the benefits you will find at Cardiac Rehab. She emphasises “It will change your perspective as well as giving you hope for a bright future”.
- You are not alone
- You can lose the fear
- Take your time – it doesn’t matter where your starting point is
- Learning to relax
- Helps you set realistic goals
- Learning to laugh again
Elaine Roles has worked in fitness since 1987. She currently runs cardiac rehab classes in Sidcup Kent which started 17 years ago as well as running a gym based CR program at Birchwood Park Golf Centre in Wilmington, Kent which has been running for the past 12 years. Visit www.heartrehabilitationexercise.com for more information.
- Laura Correia – LC4Health Ltd
From Laura’s experience as a cardiac rehab specialist she found that ‘listening’ helps cardiac rehab patients and their families the most. Suffering a heart attack and/or undergoing surgical treatment can be a terrifying experience. Laura says “Our main role as cardiac rehabilitators is to educate our patients about their health condition, to support and motivate them through their lifestyle behaviour change, and to provide a holistic approach to their care. Everyone who experiences a heart attack will face different problems and challenges. Hence, listening and making referrals to local services accordingly are two of my main priorities.”
Laura’s top tips to recovery include:
- Take your time
- Enjoy the process
- In doubt? Ask! Your exercise specialist will have access to all the information you need
- Make friends within your exercise group and have fun
- Tell us about you and your adventures and we will tell you ours
- Stay positive and be happy – whist exercising of course!
Laura is a qualified BACPR Cardiac Exercise Instructor with a Masters in Cardiovascular Rehabilitation. After working for the NHS for many years she now offers both one-to-one sessions and phase IV Cardiac Rehab classes in Hull and East Riding. Visit http://www.lc4health.com for more information.
6. Jacquie Donoghue – Jacquie D Fitness
Jacquie gives us top tips to establish a regular exercise routine after a heart attack or surgery:
1) Find a class/activity you think you will enjoy on a day/time that suits you.
2) Contact the instructor prior to starting if you have any concerns or need more information. Feel free to go and observe the class.
3) Give a class or activity a few weeks before deciding if it’s for you. It can take 4-8 weeks to get to know the exercises, the instructor, the people and establish a routine.
4) After 6-8 weeks you’ll be ready to do more exercise. Ask you instructor for info about other classes that would suit you or they can help you start self-motivated exercise eg. walking, swimming.
5) You are more likely to stick to a new routine if you exercise with others and can ‘regularly report’ what you’ve done to someone (a good instructor will be delighted to be that person!).
6) To stay motivated keep an exercise log/diary. As well as recording the type and duration of exercise also record the improvements in your physical and mental health and other benefits you’ve noticed e.g better sleep patterns, food choices.
7) Remember taking care of your health is a life long journey. Don’t be disheartened when you don’t exercise as much e.g. on holiday or if you have an illness. Just get back to your routine again and keep going!
- Neville Lewis – Body Heart and Mind
Recovery & getting back to physical activity and exercise is highly individualised & different for each person. Neville points out that he adapts exercise for each person and states “I believe it’s helpful to explain at the start that exercise does not always need to be like conventional gym workout”.
Neville always thinks about where the person’s starting point is and takes into consideration where they are in relation to strength, fitness, flexibility balance & co-ordination. Neville says “This starting point ideally would be determined by a health professional conducting a functional assessment. I also encourage self-assessment, for example – a walk from home to the shop may have felt a little challenging but the person did not need to sit down/stop. This could be the initial guide as an exercise to be completed on a regular basis to gauge progression for the future.”
How you feel while moving or exercising is also important. Neville encourages patients to measure how their body feels (e.g. your breathing, muscles) when they are moving e.g. when they are walking, doing household chores, shopping etc. Neville adds “Start with a low intensity then make steady progression. Keep all movements comfortable and don’t aim to get out of breath. It really is little & often with consistency to gain maximum benefits.”
Neville works for an NHS Trust running a cardiac rehabilitation service. He also runs his own business – Body Heart and Mind – seeing people for private cardiac rehab in London and has enjoyed doing this for a long time. Visit www.bodyheartandmind.com for more information.
- Anderson L, Oldridge N, Thompson DR et al (2016) Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. Jan 5;67(1):1-12. https://www.sciencedirect.com/science/article/pii/S0735109715071193?via%3Dihub
- Shields GE, Wells A, Doherty P, et al (2018)Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. https://heart.bmj.com/content/early/2018/04/13/heartjnl-2017-312809
- British Heart Foundation (BHF). (2016). The National Audit of Cardiac Rehabilitation Annual Statistical Report 2016. Accessed 1 November from www.cardiacrehabilitation.org.uk/docs/BHF_NACR_Report_2016.pdf